A 45-year-old hypeensive female patient, presented with complaints of recurrent sinusitis, otitis media, nasal blockage, cough, haemoptysis and chest discomfo. O/E, Nasal septal perforation Palpable purpura Non-healing ulcers in lower limbs Lab findings, Anemia Leukocytosis and raised ESR Proteinuria Increased C-ANCA levels HPE examination revealed necrotizing vasculitis and granuloma formation. Chest x-ray CECT chest Which of the following is the 1st line drug for the above condition: -

This is a case of Wegener's granulomatosis. Chest x-ray shows multiple cavitatory lesions. CT shows multiple, bilateral, and cavitary infiltrates. Wegener's granulomatosis Small vessel vasculitis Characterized by necrotizing granulomatous inflammation and pauci-immune vasculitis in small- and medium-sized blood vessels Affects the upper respiratory tract, lungs and kidneys Presents with: - Recurrent Upper respiratory tract and ear infections Lung involvement in the form of cavitatory lesions and haemoptysis Kidney involvement in the form of Type III RPGN. Cyclophosphamide and rituximab are approved for the treatment.